HomeMy WebLinkAboutDrain Layers Permit 135 Debbie Drive TOWN OF SOUTH W1 NDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N 0 77
J J pebbit Co✓ /uQ', S�GI cM /off 19 '6
Pursuant to written application, permission is e y
_ g,r censed Drain Layer
�.3named herein to. perfo the wok i di ted b� '��.t
at premises owned by - whose:address is
and to
Lay House Drain', Repair House Drain, "Lay Main, Other ,
for occupancy or use, with
Family Units, with acres.
'f a of Sewage to be connected under this
i Type g permit: SANITARY .SEWAGE ( ), INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed.work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit- to be issued to
the holder of Drain'Layer's -License No. . Permit will expire thirty' (30) days
after date of issuance." The undersigned Drain Layer hereby agrees .to all 'the terius-and
conditions set forth in the permit and the reverse side thereof. Applicant has 'received
Town Permit Nor.. and/or CHD Permit No.
Signed
Licensed Drain-Layer
The above named .Drain, Layer has a valid, license issued by the State. of. Connecticut and
has filed a satisfactory, bond and insurance policy in the name of the. Town of''South-.Windsor:
Engineering Department Date
Connection Charge Paid IQI-Icf1 3 Permit Fee: -Paid $ /j•L)O
,� Q Check Number 3
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector pate